Provider Demographics
NPI:1861184376
Name:TRUONG, KEVIN KHANH (DMD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:KHANH
Last Name:TRUONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16408 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1308
Mailing Address - Country:US
Mailing Address - Phone:954-608-6741
Mailing Address - Fax:
Practice Address - Street 1:800 E MERRITT ISLAND CSWY STE 105
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3514
Practice Address - Country:US
Practice Address - Phone:321-453-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL280801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice